Provider Demographics
NPI:1598061046
Name:ENDOCRINE CONSULTANTS OF LONG ISLAND LLP
Entity Type:Organization
Organization Name:ENDOCRINE CONSULTANTS OF LONG ISLAND LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:BREIDBART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-482-0347
Mailing Address - Street 1:29 BARSTOW ROAD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-482-0347
Mailing Address - Fax:516-482-3267
Practice Address - Street 1:29 BARSTOW ROAD
Practice Address - Street 2:SUITE 305
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-482-0347
Practice Address - Fax:516-482-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1754665207R00000X
NY175465207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF44462Medicare UPIN
NY20L591Medicare Oscar/Certification